What Is Heartburn Worth?: A Cost-Utility Analysis of Management Strategies

Authors: Heudebert, Gustavo R.¹; Centor, Robert M.¹; Klapow, Joshua C.¹; Marks, Robert²; Johnson, Lawrence²; Wilcox, C. Mel²

Source: Journal of General Internal Medicine, Volume 15, Number 3, March 2000 , pp. 175-182(8)

Publisher: Wiley-Blackwell

Abstract:

OBJECTIVE:

To determine the best treatment strategy for the management of patients presenting with symptoms consistent with uncomplicated heartburn. METHODS:

We performed a cost-utility analysis of 4 alternatives: empirical proton pump inhibitor, empirical histamine₂-receptor antagonist, and diagnostic strategies consisting of either esophagogastroduodenoscopy (EGD) or an upper gastrointestinal series before treatment. The time horizon of the model was 1 year. The base case analysis assumed a cohort of otherwise healthy 45-year-old individuals in a primary care practice. MAIN RESULTS:

Empirical treatment with a proton pump inhibitor was projected to provide the greatest quality-adjusted survival for the cohort. Empirical treatment with a histamine₂ receptor antagonist was projected to be the least costly of the alternatives. The marginal cost-effectiveness of using a proton pump inhibitor over a histamine₂-receptor antagonist was approximately $10,400 per quality-adjusted life year (QALY) gained in the base case analysis and was less than $50,000 per QALY as long as the utility for heartburn was less than 0.95. Both diagnostic strategies were dominated by proton pump inhibitor alternative. CONCLUSIONS:

Empirical treatment seems to be the optimal initial management strategy for patients with heartburn, but the choice between a proton pump inhibitor or histamine₂-receptor antagonist depends on the impact of heartburn on quality of life.

Keywords: cost-utility analysis; heartburn; proton pump inhibitor; histamine2-receptor antagonist; quality of life

Document Type: Research article

DOI: http://dx.doi.org/10.1046/j.1525-1497.2000.02639.x

Affiliations: 1: Divisions of General Internal Medicine, University of Alabama at Birmingham, Birmingham, Ala. 2: Gastroenterology, University of Alabama at Birmingham, Birmingham, Ala.

Publication date: 2000-03-01

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